School of Dentistry, University of Dundee, Dundee, UK
Clinical Effectiveness Workstream, NHS Education for Scotland, Dundee, UK.
BMJ Open Qual. 2021 Apr;10(2). doi: 10.1136/bmjoq-2019-000839.
Ensuring that healthcare is patient-centred, safe and harm free is the cornerstone of the NHS. The Scottish Patient Safety Programme (SPSP) is a national initiative to support the provision of safe, high-quality care. SPSP promotes a coordinated approach to quality improvement (QI) in primary care by providing evidence-based methods, such as the Institute for Healthcare Improvement's Breakthrough Series Collaborative methodology. These methods are relatively untested within dentistry. The aim of this study was to evaluate the impact to inform the development and implementation of improvement collaboratives as a means for QI in primary care dentistry.
A multimethod study underpinned by the Theoretical Domains Framework and the Kirkpatrick model. Quantitative data were collected using baseline and follow-up questionnaires, designed to explore beliefs and behaviours towards improving quality in practice. Qualitative data were gathered using interviews with dental team members and practice-based case studies.
One hundred and eleven dental team members completed the baseline questionnaire. Follow-up questionnaires were returned by 79 team members. Twelve practices, including two case studies, participated in evaluation interviews. Findings identified positive beliefs and increased knowledge and skills towards QI, as well as increased confidence about using QI methodologies in practice. Barriers included time, poor patient and team engagement, communication and leadership. Facilitators included team working, clear roles, strong leadership, training, peer support and visible benefits. Participants' knowledge and skills were identified as an area for improvement.
Findings demonstrate increased knowledge, skills and confidence in relation to QI methodology and highlight areas for improvement. This is an example of partnership working between the Scottish Government and NHSScotland towards a shared ambition to provide safe care to every patient. More work is required to evaluate the sustainability and transferability of improvement collaboratives as a means for QI in dentistry and wider primary care.
确保医疗保健以患者为中心、安全且无伤害是国民保健制度的基石。苏格兰患者安全计划（SPSP）是一项支持提供安全、高质量护理的国家倡议。SPSP 通过提供循证方法（如医疗改进研究所的突破系列合作方法），促进初级保健中协调一致的质量改进（QI）方法。这些方法在牙科领域相对未经测试。本研究的目的是评估影响，为在初级保健牙科中作为 QI 手段的改进合作的开发和实施提供信息。
一项基于理论领域框架和柯克帕特里克模型的多方法研究。使用基线和随访问卷收集定量数据，旨在探索改善实践质量的信念和行为。使用牙科团队成员的访谈和基于实践的案例研究收集定性数据。
111 名牙科团队成员完成了基线问卷。79 名团队成员回复了随访问卷。12 家实践，包括 2 个案例研究，参与了评估访谈。调查结果确定了积极的信念以及对 QI 的知识和技能的提高，以及对在实践中使用 QI 方法的信心增强。障碍包括时间、患者和团队参与度差、沟通和领导力不足。促进因素包括团队合作、明确的角色、强大的领导力、培训、同行支持和明显的利益。参与者的知识和技能被确定为一个需要改进的领域。
研究结果表明，参与者在 QI 方法方面的知识、技能和信心有所提高，并强调了需要改进的领域。这是苏格兰政府和 NHSScotland 之间合作的一个例子，旨在实现为每位患者提供安全护理的共同目标。需要进一步的工作来评估作为牙科和更广泛的初级保健中 QI 手段的改进合作的可持续性和可转移性。
